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P84 Uterine myoma is an ectopic souse of erythropoietin production
Abstracts
1 European
Journal
of Internal
colon and breast, WITH 5FU AND TAMOXIFEN TREATMENT AND NO recurrence. The studies performed revealed a severe hipocromic anemia (Hb=5.5 g/dL) and a platelet count of 909.OOO/mL. The upper GI endoscopy demonstrated an erosive gastritis and non-ulcerated duodenal polyps. Histology of the duodenal mucosa showed infiltration with CD 19 +, 20+ lymphocytes, IN A LYMPHOEPITHELIAL PATTERN, that, on flow citometry analisys, exibithed kappa light-chain restriction (DUODENAL MALT-LYMPHOMA). There was no involvment of other organs or the bone marrow with lymphoma cells. The Marrow biopsy showed dysmorphic maturation of megacariocytes suggestive of Essential Thrombocythemia. The patient was treated with Rituximab and Hidroxiurea with excelent tolerance. The haemoglobin levels rose to 10 g/dL and the platelet counts are still above 1,5OO,OOO/mL. An elevated platelet count is common in NHL (16% of cases), which is unusual is that this thrombocytosis be due to an intrinsically defective maturation of platelets, with FEW cases reported. The hability of the lymphoma cells to modulate maturative processes in the bone marrow is well known, but the existence of a maturative defect, common to both cell lineages, cannot be excluded. The co-existence of these two rare diagnoses raises the question of whether we are in the presence of a fortuitous association or of a novel disease entity with an as yet non-defined pathogenesis (RESULTING FROM PRIOR CHEMOTHERAPY?).
P84 Uterine Myoma is an ectopic souse of erythropoietin production I. Maslovsky, 0. Gemer, I. Shcherbina, D. Gefel (Ashkelon, IL) A syndrome characterized by elevated total body red cell mass called polycythemia. Polycythemic states include polycythemia vera (a primary marrow disorder) and large group secondary polycythemias divided in two pathogenically different types. Polycythemia, which characterized by erythron, normally responding to hypoxic states, recognized as appropriate secondary polycythemia; and a condition when erythron responds to aberrant production of erythropoietin comprises another type of secondary polycythemia, called inappropriate. All types of secondary polycythemia characterized by high level of erythropoietin contrary to polycythemia Vera. Erythropoietin secreted largely by kidney tissue. A small additional amount of erythropoietin is secreted by liver cells. It is not surprisingly, that ectopic erythropoietin production and consequently inappropriate secondary polycythemia occur in renal and liver malignancies. Other tumors only rarely comprise a cause of polycythemia. We describe a severely polycythemic young woman that suffered from huge uterine myoma. Secondary nature of her polycythemia was confirmed by high erythropoietin concentration in her plasma and complete disappeatante of polycythemia after tumor resection. A far higher concentration of erythropoetin was found in tumor cystic fluid confirming uterine souse of erythropoietin secretion.
P85 Association between alopecia and response to chemotherapy patients with Hodgkin’s lymphoma A. Elis, D. Blickstein, Y. Manor, M. Lishner (1) (Kfar Saba, Tel-Aviv,
in IL)
Purpose: To validate our clinical observation that the lack of alopecia in Hodgkin’s lymphoma patients, treated with chemotherapy, may predict for a poor response to treatment together with a low rate of bone marrow suppression. Patients and methods; A cohort study was conducted in 66 patients with Hodgkin’s lymphoma that were treated between 1991 and 2001 with at least 4 courses of doxorubicin containing chemotherapy (MOPP/ABV or ABVD) in 2 university affiliated hematology departments. Thirty-four patients sustained complete or near complete alopecia and 32 retained
Medicine
14 (2003)
S57
SI -S159
their hair or had only minimal hair loss. The 2 groups were compared by response to treatment and episodes of bone marrow suppression. Resulrs: More patients with alopecia achieved complete remission (79% vs. 31%, P
P86 Enoxaparin emholi D. Zamir,
induced
thrombocytopenia
I. Polychuck,
I. Leibovitz,
complicated T. Reitblat
with
(Ashkelon,
pulmonary IL)
Low molecular weight heparins especially are widely used in the last decade especially for prophylaxis of deep vein thrombophlebitis. Enoxaparin induced thrombocytopenia is a rare accurrance, in contrary to the high prevalence (2-5%) of this complication in patients treated with unfractionated heparin. We report here a case of a patient who developed pulmonary emboli secondary to proximal deep vein thrombophlebitis 2 weeks after having undergone prostatectomy, although he was treated prophylactically with low dose enoxaparin. His normal platelets count (255 X 109/L) decreased to 30X 109/L. Antibody testing against heparin was positive. Enoxaparin was replaced for a coumarin derivative (warfarin) and an inferior vena caval filter was inserted. Within a few days platelet count increased to lOO,OOO/iL. Pulmonary symptoms improved and he was released in a good clinical condition. Heparin induced thrombocytopenia (HIT) is discussed here as well as the alternative treatments for unfractionated heparins and low-molecular-weight heparins.
P87 Breast cancer presenting as gastric signet ring ceil carcinoma F.A.R.M. Warmerdam. B. de Valk, J.L.C. Blaauwgeers. K.J. Roozendaal (Amsterdam, NL) Background; Gastric metastases resembling linitis plastica is a rare but previously described event in the course of breast cancer. We describe a patient initially presenting with a linitis plastica and multiple metastatic bone lesions while further examination of her mastopathic breast revealed an occult, small primary breast tumour; a situation to our best knowledge not reported in literature before. Case: A 73-year-old woman with a 5 months history of epigasttic discomfort and satiety after minor food intake presented with anaemia. Biopsies taken from a gastric lesion resembling linitis plastica showed a signet ring cell type adenocarcinoma. On CAT scan performed prior to an intentionally curative gastric resection, multiple osteolytic lesions throughout the spinal cord were seen. Bone marrow biopsy showed massive infiltration by signet ring shaped carcinoma cells. Given the moderate symptoms of the disease palliative surgery was not indicated. A couple of weeks later at the outward patients clinic on physical examination, firm-to-hard breast masses were palpable and described as mastopathy. Additional immunohistochemical staining of the gastric biopsies for oestrogen and progesterone receptors nonetheless showed to be strongly positive. A mammography was done but no suspect lesions could be detected. Acknowledging possible malignancies of the breast staying clinically occult when mastopathy is present stimulated us to further
1 European
Journal
of Internal
colon and breast, WITH 5FU AND TAMOXIFEN TREATMENT AND NO recurrence. The studies performed revealed a severe hipocromic anemia (Hb=5.5 g/dL) and a platelet count of 909.OOO/mL. The upper GI endoscopy demonstrated an erosive gastritis and non-ulcerated duodenal polyps. Histology of the duodenal mucosa showed infiltration with CD 19 +, 20+ lymphocytes, IN A LYMPHOEPITHELIAL PATTERN, that, on flow citometry analisys, exibithed kappa light-chain restriction (DUODENAL MALT-LYMPHOMA). There was no involvment of other organs or the bone marrow with lymphoma cells. The Marrow biopsy showed dysmorphic maturation of megacariocytes suggestive of Essential Thrombocythemia. The patient was treated with Rituximab and Hidroxiurea with excelent tolerance. The haemoglobin levels rose to 10 g/dL and the platelet counts are still above 1,5OO,OOO/mL. An elevated platelet count is common in NHL (16% of cases), which is unusual is that this thrombocytosis be due to an intrinsically defective maturation of platelets, with FEW cases reported. The hability of the lymphoma cells to modulate maturative processes in the bone marrow is well known, but the existence of a maturative defect, common to both cell lineages, cannot be excluded. The co-existence of these two rare diagnoses raises the question of whether we are in the presence of a fortuitous association or of a novel disease entity with an as yet non-defined pathogenesis (RESULTING FROM PRIOR CHEMOTHERAPY?).
P84 Uterine Myoma is an ectopic souse of erythropoietin production I. Maslovsky, 0. Gemer, I. Shcherbina, D. Gefel (Ashkelon, IL) A syndrome characterized by elevated total body red cell mass called polycythemia. Polycythemic states include polycythemia vera (a primary marrow disorder) and large group secondary polycythemias divided in two pathogenically different types. Polycythemia, which characterized by erythron, normally responding to hypoxic states, recognized as appropriate secondary polycythemia; and a condition when erythron responds to aberrant production of erythropoietin comprises another type of secondary polycythemia, called inappropriate. All types of secondary polycythemia characterized by high level of erythropoietin contrary to polycythemia Vera. Erythropoietin secreted largely by kidney tissue. A small additional amount of erythropoietin is secreted by liver cells. It is not surprisingly, that ectopic erythropoietin production and consequently inappropriate secondary polycythemia occur in renal and liver malignancies. Other tumors only rarely comprise a cause of polycythemia. We describe a severely polycythemic young woman that suffered from huge uterine myoma. Secondary nature of her polycythemia was confirmed by high erythropoietin concentration in her plasma and complete disappeatante of polycythemia after tumor resection. A far higher concentration of erythropoetin was found in tumor cystic fluid confirming uterine souse of erythropoietin secretion.
P85 Association between alopecia and response to chemotherapy patients with Hodgkin’s lymphoma A. Elis, D. Blickstein, Y. Manor, M. Lishner (1) (Kfar Saba, Tel-Aviv,
in IL)
Purpose: To validate our clinical observation that the lack of alopecia in Hodgkin’s lymphoma patients, treated with chemotherapy, may predict for a poor response to treatment together with a low rate of bone marrow suppression. Patients and methods; A cohort study was conducted in 66 patients with Hodgkin’s lymphoma that were treated between 1991 and 2001 with at least 4 courses of doxorubicin containing chemotherapy (MOPP/ABV or ABVD) in 2 university affiliated hematology departments. Thirty-four patients sustained complete or near complete alopecia and 32 retained
Medicine
14 (2003)
S57
SI -S159
their hair or had only minimal hair loss. The 2 groups were compared by response to treatment and episodes of bone marrow suppression. Resulrs: More patients with alopecia achieved complete remission (79% vs. 31%, P
P86 Enoxaparin emholi D. Zamir,
induced
thrombocytopenia
I. Polychuck,
I. Leibovitz,
complicated T. Reitblat
with
(Ashkelon,
pulmonary IL)
Low molecular weight heparins especially are widely used in the last decade especially for prophylaxis of deep vein thrombophlebitis. Enoxaparin induced thrombocytopenia is a rare accurrance, in contrary to the high prevalence (2-5%) of this complication in patients treated with unfractionated heparin. We report here a case of a patient who developed pulmonary emboli secondary to proximal deep vein thrombophlebitis 2 weeks after having undergone prostatectomy, although he was treated prophylactically with low dose enoxaparin. His normal platelets count (255 X 109/L) decreased to 30X 109/L. Antibody testing against heparin was positive. Enoxaparin was replaced for a coumarin derivative (warfarin) and an inferior vena caval filter was inserted. Within a few days platelet count increased to lOO,OOO/iL. Pulmonary symptoms improved and he was released in a good clinical condition. Heparin induced thrombocytopenia (HIT) is discussed here as well as the alternative treatments for unfractionated heparins and low-molecular-weight heparins.
P87 Breast cancer presenting as gastric signet ring ceil carcinoma F.A.R.M. Warmerdam. B. de Valk, J.L.C. Blaauwgeers. K.J. Roozendaal (Amsterdam, NL) Background; Gastric metastases resembling linitis plastica is a rare but previously described event in the course of breast cancer. We describe a patient initially presenting with a linitis plastica and multiple metastatic bone lesions while further examination of her mastopathic breast revealed an occult, small primary breast tumour; a situation to our best knowledge not reported in literature before. Case: A 73-year-old woman with a 5 months history of epigasttic discomfort and satiety after minor food intake presented with anaemia. Biopsies taken from a gastric lesion resembling linitis plastica showed a signet ring cell type adenocarcinoma. On CAT scan performed prior to an intentionally curative gastric resection, multiple osteolytic lesions throughout the spinal cord were seen. Bone marrow biopsy showed massive infiltration by signet ring shaped carcinoma cells. Given the moderate symptoms of the disease palliative surgery was not indicated. A couple of weeks later at the outward patients clinic on physical examination, firm-to-hard breast masses were palpable and described as mastopathy. Additional immunohistochemical staining of the gastric biopsies for oestrogen and progesterone receptors nonetheless showed to be strongly positive. A mammography was done but no suspect lesions could be detected. Acknowledging possible malignancies of the breast staying clinically occult when mastopathy is present stimulated us to further